Trump is trying to repeal Obamacare again, but he still doesn't have the votes

“The plan gets better and better and better, and it has gotten really, really good,” President Trump said of a prospective healthcare replacement proposal. (European Pressphoto Agency)

Approaching the 100-day mark in office without action on the Affordable Care Act, President Trump is pushing again for a vote on the sweeping House bill to roll back the 2010 law.

But even as House Republicans and administration officials continue to discuss potential changes to the legislation, there is little evidence GOP leaders are close to getting the votes needed to get the bill out of the House.

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As of Thursday afternoon, no new vote had been scheduled by House Republican leaders. "The question is whether it can get 216 votes in the House, and the answer isn't clear at this time," said a senior GOP aide, who asked not to be identified discussing internal party discussions.

Trump, speaking at a White House news conference, also did not commit to seeking a vote next week, saying instead that he was hopeful the bill could come back for a vote soon. "The plan gets better and better and better, and it has gotten really, really good," he said.

More immediately, the White House faces a potential government shutdown unless lawmakers can agree on a new spending measure by the end of next week. Further complicating that are demands from insurers and patient advocates that the Trump administration commit to continuing to provide additional financial aid to low-income Americans who buy health coverage through Affordable Care Act marketplaces.

Many lawmakers would like the aid to be included in the new spending bill, but Trump has suggested that he might oppose that to force Democrats to accept other changes to the health bill.

House Speaker Paul D. Ryan (R-Wis.) had to cancel a planned vote on the GOP repeal bill last month after it became clear that too many rank-and-file Republicans opposed the legislation.

Since then, several lawmakers have been working to amend the bill to win support from holdouts in the conservative House Freedom Caucus and from more centrist lawmakers, many of whom were loath to support legislation that would leave millions more Americans without health insurance.

The original bill — called the American Health Care Act — would have resulted in 24 million fewer Americans with health coverage over the next decade, according to an independent analysis by the Congressional Budget Office.

And while health insurance premiums would have been lower for some consumers, many older and lower-income Americans would have been priced out of coverage by the GOP plan.

The House legislation would dismantle the Obamacare extensive system for expanding health insurance coverage to millions of Americans, cutting nearly $1 trillion in federal aid that has allowed states to expand the Medicaid safety net programs and scaling back tax subsidies that help millions of low- and middle-income Americans buy commercial health plans.

At the same time, the House bill would repeal major taxes that the current law imposed to fund the expansion of health coverage.

That would deliver major tax breaks to the medical device and insurance industries and to wealthy Americans. The House bill also would scrap the unpopular requirement in the current law that Americans have insurance or pay a penalty.

Despite rolling back key pillars of Obamacare, the House bill still generated fierce resistance from many conservative lawmakers, who said it did not go far enough.

Trump administration officials, eager to score a win amid a rocky start to the president's term, have been pushing for a new vote.

But an increasing number of GOP lawmakers have been voicing new concerns, amid a widespread public backlash against the House legislation.

"They go further right, they're going to lose more moderates," said Rep. Ted Lieu (D-Torrance). "I'm not sure how they do this…. Everyone knows it's just going to die in the Senate. Really this is all about face-saving."

The changes to the House Republican bill now under discussion — first reported by Huffington Post — would further weaken several key consumer protections in the current law, including the guarantee that Americans can get coverage even if they are sick.

Republican lawmakers have been exploring ways to give states the flexibility to scrap these protections. States could, for example, once again allow insurers to charge sick consumers more than healthy ones and could lift requirements that all health plans cover a basic set of benefits, such as mental health and maternity care.

Rep. Tom MacArthur (R-N.J.), a centrist who has been working on the new language, said in a Facebook post that sick patients would still be able to get coverage because states would be required to offer a special health plan, known as a high-risk pool, for people unable to get other coverage.

"This amendment will make coverage of preexisting conditions sacrosanct for all Americans," he said.

But these high-risk pools were almost universally unsuccessful before the advent of Obamacare, and the new GOP proposals drew swift criticism from many patient advocates and others.

"This latest attempt to repeal the ACA is full of broken promises and deceptive rhetoric," said Debra Ness, president of the National Partnership for Women & Families.

"While President Trump and leaders in Congress promised to protect health coverage for those with preexisting conditions, this new plan undermines this critically important and wildly popular ACA provision."